Enchanted Castle Presenting Sponsor ($20,000)    In-Kind Sponsor

    Golden Coach Sponsor ($10,000) Providing:

    Crystal Slipper Sponsor ($5,000)  _______________________________________

    Silver Tiara Sponsor ($2,500)

    Moonlight & Stardust Sponsor ($1,000)    _______________________________________

    Special Sponsor

     Providing:  $____________

    

I would like to contribute $_______  to support the mission of Safe Places.

I would like to purchase _________ tickets to the Ball at $125 each.  Total $__________.

I would like to contribute $___________ to honor:  ___________________________________

Name  ___________________________________________

          

           ___________________________________________

               (as you would like to be recognized in event collateral)

Address __________________________________________

      __________________________________________

Contact Name __________________________________________

Phone Number __________________________________________

E-Mail Address __________________________________________

Payment:Safe Places kindly requests payment in full within 30 days of receipt of this commitment.

  If you would like to discuss other payment terms, please check the appropriate box below:

                        Bill us immediately; we’re happy to pay within 30 days.

                                      (checks should be made out to Safe Places: The Center for Healing and Hope, Inc.)

                        Please contact us to talk about payment terms.

To pay by credit card, click here:

                         ________________________________________________________________________

                       Signature                                                                           Date

You may print this form and fax completed form to: 501-217-0985

Or mail to: 

Safe Places Business Office

2607 Lehigh Drive

Little Rock, AR 72204

We are not able to count gifts or sponsorships until they are committed in writing. 

Yes, we want to support the Safe Places Inaugural Gala

Honoring

Dr. Karen Worley

for her many years of therapeutic intervention for child victims of sexual abuse and their families through her work as director of the Family Treatment Program, a collaborative effort of UAMS Department of Pediatrics and Arkansas Children’s Hospital.

And Honoring

The Rev Dr. Joanna J. Seibert and Dr. Robert W. Seibert

for their dedication and commitment to the Mission and Vision of Safe Places and for their many contributions to the spiritual, emotional and physical welfare of the children of this community.

Click the Safe Places Tree to go to the

Safe Places Website.

If you prefer to complete a fillable form and submit it online please click the golden coach.